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Perception of mental illness differs across cultures

Brandon Knettel spent two years working with a Tanzanian university to aid in mental health treatment.

It might seem obvious that a person with depression or severe anxiety needs help, but definitions of mental illness are not universal around the world. That’s something that Brandon Knetel is working to address.

Knettel, a doctoral student in counseling psychology at Lehigh, is studying mental health conditions in Tanzania. In 2009 and 2010, Knettel taught at a Tanzanian university with a counseling education program to teach primary and secondary school teachers to recognize mental health problems in their students—for instance, being able to recognize signs of abuse and neglect that may be affecting a child’s emotional well-being.

“I completely fell in love with the country’s culture,” Knettel says. “I also saw that psychological services are on the rise there, for better or worse. I want to inform the development of those services—all while keeping in mind that it’s a very culturally sensitive matter.”

Before Lehigh, Knettel attended The College of St. Scholastica in Duluth, Minn. He spent the first year of his master’s degree at Australia’s Bond University, finishing at the University of St. Thomas in St. Paul, Minn. He returned to Tanzania for one month in 2012 and will return in 2013 to continue his research. He plans to finish his doctorate in September of 2015.

Knettel is also a volunteer and practicum student at The Philadelphia Refugee Mental Health Collaborative, a group of resettlement agencies, mental health providers, physicians and arts organizations working to link refugees to culturally and linguistically appropriate mental healthcare.

He first became interested in psychology in high school. “Of course, my interests have expanded as I’ve had more opportunities to travel,” he says. “And that has helped me to understand that psychology as we know it is largely a Western, developed country phenomenon. For psychology to be truly global, we need to allow it to expand to include the diverse perspectives of people all over the world.”

He decided to study at Lehigh because the university’s counseling psychology emphasizes multicultural research and practice. He says his adviser and other faculty have supported his international focus, and he’s also built strong partnerships with other parts of the university.

Knettel takes an ethnographic approach to his research. “My view is that no intervention can be effective if it isn’t informed by and rooted in the Tanzanian culture,” he says. As part of his studies, he is interviewing mental health providers and the general public to get a better sense of how people in the East African country view mental illness.

For instance, depression and anxiety, two of the main mental health problems affecting Americans, are hardly seen as a priority in Tanzanian culture, he says. More visible issues, such as schizophrenia and other forms of psychosis, gain more attention.

“Historically, Tanzania has been among the poorest countries in the world,” Knettel says. “People here are still starving or dying of malaria and other diseases that should be preventable. Only now that they are starting to prevent some of these more basic problems can they begin to focus more on mental, in addition to physical, health.”

Another contributor to the unique Tanzanian perception of mental illness is that severe mental issues are more visible in everyday society, Knettel says. In more developed countries, people with such diagnoses are not as obvious, as they are often placed in hospitals or residential treatment facilities.

“When people talk about mental illness across cultures, there is often a very big cultural disconnect,” he says. “Oftentimes, rather than try to understand the cultural discrepancy, we’ll immediately try to solve everything as if it is a Western problem requiring a Western solution.

“Instead, the key is defining the problem and asking if we have a good understanding of it in the context of a certain culture,” he says. “Nothing can work if the treatment doesn’t match the illness.”